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PowerPoint Slideshow about 'NEW ORAL ANTICOAGULANTS' - dagan

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Dabigatran anticoagulants is that because their action is at the end of the coagulation cascade is that they are irreversible in the event

Promoted as not requiring monitoring cf, with warfarin which has multiple drug, dietary and time of ingestion interactions

Has been aggressively promoted by the drug company to GP’s by a “familiarisation” program

Inadequate outline of potential overdose in elderly patients > 75 years and patients with renal impairment

No effective antidote for anticoagulant related bleeding

Rivaroxaban anticoagulants is that because their action is at the end of the coagulation cascade is that they are irreversible in the event and Apixaban are factor Xa inhibitors only licenced currently as thromboprophylaxis for hip and knee replacement surgery however will be licenced for use in AF in 2013

Although the drug company claims there are less serious haemorrhagic complications cf. warfarin we have experienced an increased incidence of GI bleeding especially in patients >75yo and with renal impairment. The incidence of cerebral haemorrhage was less but this included patients on warfarin + ASA

The only effective reversal of concentration of all 3 of the new anticoagulants however to date there is no correlation with the level of the drug and its anticoagulant effectdabigatran is haemodialysis

The use of FV11a is unproven but has been used in desperate situations

Compared to warfarin dabigatran causes more GI bleeding, myocardial infarction, has no antidote and costs significantly more than warfarin and there is no laboratory test to monitor adherence

The new anticoagulants are going to have an important role in thromboprophylaxis however the rush by drug companies to promote these expensive new agents has not been balanced by appropriate precautionary advice about the lack of an antidote in the event of bleeding, the lack of laboratory monitoring, the lack of clinical trialsin the patient group most likely tobe prescribed these agents ie, patients > 75 and with renal impairment